Treatment of femoral neck fractures with the sliding compression screw.

Twenty-nine patients with intracapsular fractures of the femur were treated with a sliding compression screw. The overall incidence of unsatisfactory results was 48%. In the combined group of Garden III-type and Garden IV-type fractures, 58% had unsatisfactory results. The Garden IV type fractures, considered separately, had 89% unacceptable results. The most significant factors associated with an unsatisfactory result were: (1) poor reduction; (2) poor alignment or depth of the screw; and (3) the use of the long threaded lag screw. Inability to control the proximal fragment during the procedure made it difficult to maintain satisfactory reduction and may have contributed to avascular necrosis in seven of the 29 hips. Displaced fractures of the femoral neck are difficult to reduce and transfix. The sliding compression screw did not compensate for a technically poor reduction or unsatisfactory surgical placement of the device.